From the Guidelines
Streptococcal pharyngitis, commonly known as strep throat, typically presents with sudden onset of sore throat, pain when swallowing, fever above 101°F (38.3°C), red and swollen tonsils often with white patches or streaks of pus, tiny red spots on the roof of the mouth, and swollen, tender lymph nodes in the neck. Other symptoms may include headache, nausea, vomiting, body aches, and occasionally a fine, red rash (scarlet fever). Notably, strep throat usually does not cause cough, runny nose, hoarseness, or conjunctivitis, which helps distinguish it from viral infections. These symptoms typically appear 2-5 days after exposure to the Streptococcus pyogenes bacteria. The infection spreads through respiratory droplets and close contact with infected individuals. If you experience these symptoms, seek medical attention promptly as strep throat requires diagnosis with a rapid strep test or throat culture and treatment with antibiotics (typically penicillin or amoxicillin for 10 days) to prevent complications like rheumatic fever or kidney inflammation, as suggested by the American College of Physicians and the Centers for Disease Control and Prevention 1.
Some key points to consider when evaluating symptoms of streptococcal pharyngitis include:
- The presence of persistent fever, rigors, night sweats, tender lymph nodes, tonsillopharyngeal exudates, scarlatiniform rash, palatal petechiae, and swollen tonsils, which may indicate a bacterial cause 1.
- The use of clinical scoring criteria, such as the modified Centor criteria, to help determine the likelihood of a bacterial cause 1.
- The importance of testing for group A Streptococcus with a rapid antigen detection test, throat culture, or both, in patients with symptoms suggesting a bacterial cause 1.
- The need for prompt treatment with antibiotics to prevent complications like rheumatic fever or kidney inflammation, as well as to reduce the duration of symptoms 1.
It is essential to note that while most pharyngitis cases are caused by viruses, antibiotics are often prescribed unnecessarily, and the benefits of antibiotic therapy must be weighed against the potential risks and adverse effects 1.
From the Research
Strep Symptoms
The symptoms of streptococcal pharyngitis include:
- Sore throat
- Fever greater than 100.4 degrees F (38 degrees C) 2, 3, 4
- Tonsillar exudates
- Cervical adenopathy (enlarged and tender lymph nodes in the neck) 2, 3, 4
- Headache 3, 4
- Malaise 4
- Chills 4
- Pharyngeal or tonsillar exudate 4
- Bilateral tender cervical lymphadenopathy (enlarged and tender lymph nodes on both sides of the neck) 3
Distinguishing from Viral Pharyngitis
Cough, coryza, conjunctivitis, and diarrhea are more common with viral pharyngitis and suggest a viral cause 2, 3, 4. The presence of these symptoms can help distinguish between streptococcal and viral pharyngitis.
Diagnosis and Treatment
Diagnosis of streptococcal pharyngitis is supported by the patient's history and physical examination, and can be confirmed by throat culture or rapid antigen detection testing 2, 4. Penicillin is the treatment of choice for streptococcal pharyngitis, although alternatives such as amoxicillin, erythromycin, and cephalosporins may be used in patients with penicillin allergy 5, 2, 6, 4.